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1 Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
Key words: alopecia areata incognita, diffuse alopecia areata, yellow dots, histopathology, therapy
Citation: Alessandrini A, Starace M, Bruni F, Brandi N, Baraldi C, Misciali C, Fanti PA, Piraccini BM. Alopecia areata incognita and diffuse
alopecia areata: clinical, trichoscopic, histopathological, and therapeutic features of a 5-year study. Dermatol Pract Concept. 2019;9(4):272-277.
DOI: https://doi.org/10.5826/dpc.0904a05
Accepted: July 23, 2019; Published: October 31, 2019
Copyright: ©2019 Alessandrini et al. This is an open-access article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are
credited.
Funding: None.
Competing interests: The authors have no conflicts of interest to disclose.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Aurora Alessandrini, MD, Department of Experimental, Diagnostic and Specialty Medicine, Division of
Dermatology, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy. Email: aurora.alessandrini@alice.it
ABSTRACT Background: Alopecia areata is a nonscarring hair loss that usually causes round patches of baldness,
but alopecia areata incognita (AAI) and diffuse alopecia areata (DAA) can cause a diffuse and acute
pattern of hair loss.
Objective: To analyze the clinical, trichoscopic, histological, and therapeutic features of AAI and
DAA.
Methods: The study was designed to include data of patients with histological diagnosis of AAI and
DAA enrolled in our Hair Disease Outpatient Consultations.
Results: DAA had a greater involvement of the parietal and anterior-temporal regions, while AAI
manifested itself mainly in the occipital-parietal regions. The most frequent pattern was empty yellow
dots, yellow dots with vellus hairs, and small hair in regrowth, but the presence of pigtail hair was
found almost exclusively in those with AAI. In cases of DDA, the finding of dystrophic hair and black
dots was more frequent. The most frequent trichoscopic sign in both diseases was the presence of emp-
ty yellow dots, which, however, were described in a higher percentage in cases of DAA. The diseases
have a benign course and are responsive to topical steroid therapy.
Conclusions: Trichoscopy is very important for the differential diagnosis between the 2 diseases
and to select the best site for biopsy. In the presence of diffuse hair thinning, these entities must be
considered.
A
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